Abstract T P307: Similar Rates of Early Cognitive Dysfunction after Intracerebral Hemorrhage and Acute Ischemic Stroke

Introduction: Post-stroke cognitive dysfunction (CD) affects at least 1/3 of acute ischemic stroke (AIS) patients when assessed at 3 months. Limited data exists on CD in intracerebral hemorrhage (ICH). The role of early, in-hospital cognitive screening using the brief Montreal Cognitive Assessment (mini MoCA) is being investigated at our center. Hypothesis: We assessed the rates of early CD in ICH and AIS and hypothesized that even minor deficits from these disorders causes significant CD. Methods: 1218 consecutive stroke patients admitted from 2/13 to 12/13 were reviewed; 610, 442 with AIS and 168 with ICH, with admission NIHSS and mini MoCAs were included in the final analyses. CD was defined as mini MoCA <9 (max 12). Poor outcome was defined as discharge mRS 4-6. Stroke severity was stratified by NIHSS score of 0-5, 6-10, 11-15, 16-20, 21-42 as in ECASS-I . Chi-squared tests and univariate logistic regression analyses were performed. Results: Baseline characteristics are shown in table 1. AIS and ICH groups were similar with regard to race, gender and stroke severity. ICH patients were younger, had longer stroke service lengths of stay and poorer outcomes than AIS patients (p=0.03, p<0.001, p<0.001). No difference was seen in rates of CD between AIS and ICH patients (60% vs. 57%, p=0.36, OR 1.2 (CI 0.8-1.7)). CD rates ranged from 36% for NIHSS 0-5 to 96% for 21-42 (figure 1). Older patients were twice as likely to have CD (p<0.001, OR 2.2 (CI 1.6 - 3.0)). Patients with CD had five times the odds of having a poor outcome compared to the cognitively intact (p<0.001, OR 5.2 (CI 3.4-7.7)). In univariate logistic regression analyses, age was a significant predictor of CD in AIS, but not in ICH (p= <0.001, p=0.06). Conclusion: Post-stroke CD is common across all severities and occurs at similar rates in AIS and ICH. More than 1/3 of patients with minor deficits (NIHSS 0-5) had CD in the acute hospital setting. Whether early CD is predictive of long term cognitive outcomes deserves further study.

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Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015889 ◽

2020 ◽

Vol 13 (1) ◽

pp. 14-18 ◽

Cited By ~ 5

Author(s):

Noel van Horn ◽

Helge Kniep ◽

Hannes Leischner ◽

Rosalie McDonough ◽

Milani Deb-Chatterji ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Logistic Regression Analysis ◽

Stroke Severity ◽

Stroke Patients ◽

Poor Clinical Outcome ◽

Poor Outcome

BackgroundIn patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.MethodsPatients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as ‘poor outcome’. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.Results123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.ConclusionPoor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.

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Abstract 16967: Increased Blood Pressure Variability is Associated With Worse Outcome in Acute Ischemic Stroke

Circulation ◽

10.1161/circ.132.suppl_3.16967 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Adam de Havenon ◽

Haimei Wang ◽

Greg Stoddard ◽

Lee Chung ◽

Jennifer Majersik

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Harmful Effect ◽

Final Analysis ◽

Ordinal Logistic Regression ◽

Stroke Severity ◽

The Mean

Background: Increased blood pressure variability (BPV) is detrimental in the weeks to months after ischemic stroke, but it has not been adequately studied in the acute phase. We hypothesized that increased BPV in acute ischemic stroke (AIS) patients would be associated with worse outcome. Methods: We retrospectively reviewed inpatients at our hospital between 2010-2014 with an ICD-9 code of AIS; 213 were confirmed to have AIS by a vascular neurologist. A modified Rankin Score (mRS) after discharge was available in 148/213, at a mean of 86 ± 60 days. In 45/213 the discharge mRS was either 0 or 6, in which case they were included in the final analysis. BPV was measured as the standard deviation (SD) of each patient’s systolic blood pressure readings during the first 24 hours and 5 days of hospitalization (9,844 total readings), or until discharge if discharged in <5 days (Figure 1). The SBP SD was further divided in quartiles. A multivariate ordinal logistic regression with the outcome of mRS, the primary predictor of quartiles of SBP SD, and baseline NIH stroke scale (NIHSS) to control for initial stroke severity. Results: Mean±SD age was 64.2 ± 16.3 years, NIHSS was 12.6 ± 7.9, and mRS was 2.7 ± 2.1. The mean SBP SDs for the first 24 hours and 5 days were 12.1 ± 6.2 mm Hg and 14.1 ± 4.9 mm Hg. In the ordinal logistic regression model, the quartiles of SBP SD for the first 24 hours and 5 days were positively associated with higher mRS (OR = 1.37, 95% CI 1.01 - 1.74, p = 0.009; OR = 1.30, 95% CI 1.03 - 1.63, p = 0.028). This effect became even more pronounced in patients with the highest quartile of variability (OR = 2.76, 95% CI 1.29 - 5.88, p = 0.009; OR = 2.10, 95% CI 1.01 - 4.36, p = 0.046). Conclusion: In our cohort of 193 patients with AIS, there was a significant association between increased systolic BPV and worse functional outcome, after controlling for initial stroke severity. This data suggests that increased BPV may have a harmful effect for AIS patients, which warrants a prospective observational study.

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Elevation of troponin I in acute ischemic stroke

PeerJ ◽

10.7717/peerj.1866 ◽

2016 ◽

Vol 4 ◽

pp. e1866 ◽

Cited By ~ 9

Author(s):

Yu-Chin Su ◽

Kuo-Feng Huang ◽

Fu-Yi Yang ◽

Shinn-Kuang Lin

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Barthel Index ◽

Troponin I ◽

Clinical Deterioration ◽

Stroke Severity ◽

Nihss Score ◽

Poor Outcome

Background. Cardiac morbidities account for 20% of deaths after ischemic stroke and is the second commonest cause of death in acute stroke population. Elevation of cardiac troponin has been regarded as a prognostic biomarker of poor outcome in patients with acute stroke.Methods. This retrospective study enrolled 871 patients with acute ischemic stroke from August 2010 to March 2015. Data included vital signs, laboratory parameters collected in the emergency department, and clinical features during hospitalization. National Institutes of Health Stroke Scale (NIHSS), Barthel index, and modified Rankin Scale (mRS) were used to assess stroke severity and outcome.Results.Elevated troponin I (TnI) > 0.01 µg/L was observed in 146 (16.8%) patients. Comparing to patients with normal TnI, patients with elevated TnI were older (median age 77.6 years vs. 73.8 years), had higher median heart rates (80 bpm vs. 78 bpm), higher median white blood cells (8.40 vs. 7.50 1,000/m3) and creatinine levels (1.40 mg/dL vs. 1.10 mg/dL), lower median hemoglobin (13.0 g/dL vs. 13.7 g/dL) and hematocrit (39% vs. 40%) levels, higher median NIHSS scores on admission (11 vs. 4) and at discharge (8 vs. 3), higher median mRS scores (4 vs3) but lower Barthel index scores (20 vs. 75) at discharge (p< 0.001). Multivariate analysis revealed that age ≥ 76 years (OR 2.25, CI [1.59–3.18]), heart rate ≥ 82 bpm (OR 1.47, CI [1.05–2.05]), evidence of clinical deterioration (OR 9.45, CI [4.27–20.94]), NIHSS score ≥ 12 on admission (OR 19.52, CI [9.59–39.73]), and abnormal TnI (OR 1.98, CI [1.18–3.33]) were associated with poor outcome. Significant factors for in-hospital mortality included male gender (OR 3.69, CI [1.45–9.44]), evidence of clinical deterioration (OR 10.78, CI [4.59–25.33]), NIHSS score ≥ 12 on admission (OR 8.08, CI [3.04–21.48]), and elevated TnI level (OR 5.59, CI [2.36–13.27]).C-statistics revealed that abnormal TnI improved the predictive power of both poor outcome and in-hospital mortality. Addition of TnI > 0.01 ug/L or TnI > 0.1 ug/L to the model-fitting significantly improvedc-statistics for in-hospital mortality from 0.887 to 0.926 (p= 0.019) and 0.927 (p= 0.028), respectively.Discussion.Elevation of TnI during acute stroke is a strong independent predictor for both poor outcome and in-hospital mortality. Careful investigation of possible concomitant cardiac disorders is warranted for patients with abnormal troponin levels.

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Headache as a Predictive Factor of Severe Systolic Hypertension in Acute Ischemic Stroke

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100002602 ◽

2003 ◽

Vol 30 (3) ◽

pp. 210-214 ◽

Cited By ~ 7

Author(s):

Yoon-Ho Hong ◽

Yong-Seok Lee ◽

Seong-Ho Park

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Cerebral Infarction ◽

Acute Ischemic Stroke ◽

Acute Cerebral Infarction ◽

Stroke Severity ◽

Plasma Catecholamine ◽

Catecholamine Level ◽

Stroke Subtypes ◽

The Mean

ABSTRACT:Background:Elevation of blood pressure (BP) is common in acute cerebral infarction, with several studies reporting a high plasma catecholamine level or previous hypertension as a contributory factor. However, more comprehensive studies on associated clinical parameters are lacking. Our main aim in undertaking this study was to correlate clinical variables associated with a BPelevation in acute ischemic stroke.Methods:Consecutive patients who were admitted to the emergency room and diagnosed with an acute cerebral infarction within 24 hours after the onset of symptoms were investigated. A BP elevation was defined as a high systolic (³200mmHg) or diastolic (³110 mmHg) pressure. The mean systolic and diastolic BP were compared between the different stroke subtypes, lesion locations (carotid vs. vertebrobasilar), and hemispheric sides. The frequency of symptoms, risk factors, location of the infarct, stroke severity, vascular status and laboratory abnormalities were analyzed in order to build a regression model.Results:One hundred thirty-one patients were recruited (M:F=60:71, mean age 66±12 years) and an elevated BP was identified in 33 patients (25.2%). The mean systolic and diastolic BP did not differ significantly between the stroke subtypes, lesion locations, and hemispheric sides. According to univariate logistic regression, an elevated systolic BP correlated with headache (p=0.01) and underlying hypertension (p=0.02) while an elevated diastolic BP correlated with underlying hypertension (p=0.01). Multivariate logistic regression analysis revealed previous hypertension (OR 5.21, 95% CI 1.40-19.37) and headache (OR 4.09, 95% CI 1.44-11.66) to be independent predictors of an elevated systolic BP.Conclusions:Headache itself is closely associated with severe systolic BP elevation in acute ischemic stroke. Whether treatment of elevated BP improves headache and clinical outcome is not yet known, necessitating future controlled studies.

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Age‐Specific and Sex‐Specific Trends in Life‐Sustaining Care After Acute Stroke

Journal of the American Heart Association ◽

10.1161/jaha.121.021499 ◽

2021 ◽

Author(s):

Raed A. Joundi ◽

Eric E. Smith ◽

Amy Y. X. Yu ◽

Mohammed Rashid ◽

Jiming Fang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Feeding Tube ◽

Stroke Severity ◽

Over Time ◽

Age And Sex

Background Temporal trends in life‐sustaining care after acute stroke are not well characterized. We sought to determine contemporary trends by age and sex in the use of life‐sustaining care after acute ischemic stroke and intracerebral hemorrhage in a large, population‐based cohort. Methods and Results We used linked administrative data to identify all hospitalizations for acute ischemic stroke or intracerebral hemorrhage in the province of Ontario, Canada, from 2003 to 2017. We calculated yearly proportions of intensive care unit admission, mechanical ventilation, percutaneous feeding tube placement, craniotomy/craniectomy, and tracheostomy. We used logistic regression models to evaluate the association of age and sex with life‐sustaining care and determined whether trends persisted after adjustment for baseline factors and estimated stroke severity. There were 137 358 people with acute ischemic stroke or intracerebral hemorrhage hospitalized during the study period. Between 2003 and 2017, there was an increase in the proportion receiving care in the intensive care unit (12.4% to 17.7%) and mechanical ventilation (4.4% to 6.6%). There was a small increase in craniotomy/craniectomy, a decrease in percutaneous feeding tube use, and no change in tracheostomy. Trends were generally consistent across stroke types and persisted after adjustment for comorbid conditions, stroke‐center type, and estimated stroke severity. After adjustment, women and those aged ≥80 years had lower odds of all life‐sustaining care, although the disparities in intensive care unit admission narrowed over time. Conclusions Use of life‐sustaining care after acute stroke increased between 2003 and 2017. Women and those at older ages had lower odds of intensive care, although the differences narrowed over time. Further research is needed to determine the reasons for these findings.

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Elevated plasma D-dimer level is associated with short-term poor outcome in patients with acute ischemic stroke: a prospective, observational study

10.21203/rs.2.9184/v1 ◽

2019 ◽

Author(s):

Tao Yao ◽

Bo-Lin Tian ◽

Gang Li ◽

QIN CUI ◽

Cui-fang Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Clinical Laboratory ◽

Predictive Marker ◽

Stroke Severity ◽

Elevated Plasma ◽

Short Term ◽

Poor Outcome ◽

D Dimer

Abstract Background Elevated level of D-dimer increases the risk of ischemic stroke, stroke severity and progression of stroke status, but the association between D-dimer and functional outcome is unclear. The aim of this study is to investigate whether Plasma D-dimer level is a determinant of short-term poor functional outcomes in patients with acute ischemic stroke (AIS). Methods This prospective study included 877 patients with AIS provided plasma D-dimer level after stroke onset. Patients were categorized per D-dimer level: Quartile 1(≤0.24 mg /L), Quartile 2 (0.25–0.56 mg /L), Quartile 3 (0.57–1.78 mg /L), and Quartile 4 (>1.78mg /L). Each patient’s medical record was reviewed, and demographic, clinical, laboratory and neuroimaging information was abstracted. Functional outcome at 90 days was assessed with the modified Rankin Scale (mRS). Results Of 877 patients were included (mean age, 64 years; male, 68.5%), poor outcome was present in 302 (34.4%) patients. After adjustment for potential confounding variables, higher D-dimer level on admission was associated with poor outcome (adjusted odds ratio [aOR] 2.257, 95% CI1.349-3.777 for Q4:Q1; P trend = 0.004). According to receiver operating characteristic (ROC) analysis, the best discriminating factor was a D-dimer level ≥0.315 mg/L for pour outcome [area under the ROC curve (AUC) 0.657; sensitivity 83.8%; specificity 41.4%]. Conclusion Elevated plasma D-dimer level on admission was significantly associated with increased poor outcome after admission for AIS, suggesting the potential role of D-dimer as a predictive marker for short-term poor outcomes in patients with AIS.

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Low T3 Level and Prognosis of Acute Ischemic Stroke: A Comparative Analysis

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v18i2.35223 ◽

2018 ◽

Vol 18 (2) ◽

pp. 145-148

Author(s):

Hosne Ara Rahman ◽

Mahbub Ur Rahman ◽

Jasmine Ara Haque ◽

Samira Sharmin ◽

Anup Kumar Saha

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Neurological Impairment ◽

Functional Improvement ◽

Stroke Severity ◽

Cross Sectional ◽

Post Stroke ◽

Low T3 ◽

Level Group

Objectives: Neuroendocrine profile is significantly altered in acute ischemic stroke. Increasing evidences suggested that low T3 levels immediately following acute ischemic stroke is associated with greater stroke severity, higher mortality rates and poorer functional outcome. The objective of this study was to see the possible association of serum T3 level with severity of acute ischemic stroke as well as post stroke recovery.Material & Methods: It was a prospective cross sectional study. From October 2014 to June 2015 patients with acute ischemic stroke, presented within 48 hours of onset of symptoms having radiologically confirmed cerebral infarct were enrolled in this study. Blood for thyroid hormone estimation was collected within 48 hours of onset of symptom. Neurological impairment and improvement were assessed using National Institute of Health Stroke Scale (NIHSS) score together with modified Rankin Scale (mRS) on admission day and at 4 weeks post stroke follow-up visit.Result: A total 83 patients met all inclusion criteria were studied. Mean age was 63.4 ± 15.6 years (range 47-79 years). Among eighty three patients 49 (59%) had normal T3 level and rest 34 (41%) had low T3 level. Mean T3 level was 0.4 ± 0.3 ng/ml and 1.8 ±0.5 ng/ml in lowT3 and normal T3 level group respectively. Based on NIHSS scores on admission, a much higher portion of patients (73.5%) belonged to lowT3 level group fell into moderate-to-severe category while majority of patients (53.0%) fell into mild category for normal T3 level group. In post stroke follow up, about 63.2 % patients with normal T3 level showed favorable neurological functional improvement compared to 38.2% having low T3 level (Chi square=4.9, P<0.05).Conclusion: In patients with acute ischemic stroke lower T3 level elevated the risk of poor functional outcome.Bangladesh J. Nuclear Med. 18(2): 145-148, July 2015

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TRIAGE-STROKE: Treatment strategy In Acute larGE vessel occlusion: Prioritize IV or endovascular treatment—A randomized trial

International Journal of Stroke ◽

10.1177/1747493019869830 ◽

2019 ◽

Vol 15 (1) ◽

pp. 103-108 ◽

Cited By ~ 1

Author(s):

Anne Behrndtz ◽

Søren P Johnsen ◽

Jan B Valentin ◽

Martin F Gude ◽

Rolf A Blauenfeldt ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Hospital Setting ◽

Intravenous Thrombolysis ◽

Large Vessel ◽

Stroke Severity ◽

Study Results ◽

Primary Stroke Center ◽

Stroke Center

Rationale For patients with acute ischemic stroke and large vessel occlusions, intravenous thrombolysis and endovascular therapy are standard of care, but the effect of endovascular therapy is superior to intravenous thrombolysis. If a severe stroke with symptoms indicating large vessel occlusions occurs in the catchment area of a primary stroke center, there is equipoise regarding optimal transport strategy. Aim For patients presenting with suspected large vessel occlusions (PASS ≥ 2) and a final diagnosis of acute ischemic stroke, we hypothesize that bypassing the primary stroke center will result in an improved 90-day functional outcome. Sample size We aim to randomize 600 patients, 1:1. Design A national investigator-driven, multi-center, randomized assessor-blinded clinical trial. The Prehospital Acute Stroke Severity Scale has been developed. It identifies most patients with large vessel occlusions in the pre-hospital setting. Patients without a contraindication for intravenous thrombolysis are randomized to either transport directly to a comprehensive stroke centers for intravenous thrombolysis and of endovascular therapy or to a primary stroke center for intravenous thrombolysis and subsequent transport to a comprehensive stroke centers for of endovascular therapy, if needed. Outcomes The primary outcome will be the 90-day modified Rankin Scale score (mRS) for all patients with acute ischemic stroke. Secondary outcomes include 90-day mRS for all randomized patients, all patients with ischemic stroke but without large vessel occlusions, and patients with hemorrhagic stroke. The safety outcomes include severe dependency or death and time to intravenous thrombolysis for ischemic stroke patients. Discussion Study results will influence decision making regarding transport strategy for patients with suspected large vessel occlusions.

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Abstract 147: The Association Between Hematocrit and Mortality among Ischemic Stroke Patients

Stroke ◽

10.1161/str.43.suppl_1.a147 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Jason J Sico ◽

Laura J Myers ◽

Dede Ordin ◽

Linda S Williams ◽

Dawn M Bravata

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Mortality ◽

Multivariate Logistic Regression ◽

P Values ◽

Time Points ◽

Post Stroke ◽

One Year ◽

The Relationship

Introduction: Anemia is associated with higher mortality among patients with such non-stroke vascular conditions as heart failure and myocardial infarction. Less is known regarding the relationship between anemia and mortality among patients with acute ischemic stroke. Methods: Medical records were abstracted for a sample of 3965 veterans from 131 Veterans Health Administration (VHA) facilities who were admitted for a confirmed diagnosis of ischemic stroke (fiscal year 2007). Hematocrit (Hct) values from 24-hours of admission were categorized into 6-tiers (≤27%, 28-32%, 33-37%, 38-42%, 43-47%, ≥48%). We excluded patients with: female gender (n=95), incomplete Hct data (n=94), thrombolysis (n=32), and inconsistent death dates (n=6). We used multivariate logistic regression to examine the relationship between anemia and in-hospital, 30-day, 60-day and one-year mortality using multivariate logistic regression models for each time point, adjusting for age, NIHSS, comorbidity (including pneumonia), and Acute Physiology and Chronic Health Evaluation (APACHE)-III scores. The discrimination (c-statistics) and calibration (Hosmer-Lemeshow goodness of fit [HLGOF]) statistics were generated to gauge model performance and fit. Results: Approximately 2.1% of the N=3750 patients presented with Hcts ≤27%, 6.2% were 28-32%, 17.9% were 33-37%, 36.4% were 38-42%, 28.2% were 43-47%, and 9.1% were ≥48%. Adjusted mortality odds at all time points were 2.5 to 3.5 times higher for those with ≤Hct 27% (p values < 0.013 for in-hospital and 30-day mortality; p values at 6 months and one year were 0.002 and 0.001, respectively). Mortality risk at 6 months and 1 year showed a significant and dose-response relationship to Hct for all Hct groups <38%. High Hcts were independently associated only with in-hospital mortality and only in those with Hct ≥48 (OR 2.9, p=0.004). Models performed well across time points (C=0.813, HLGOF=0.9684 [in-hospital]; C=0.832, HLGOF=0.8186 [30-day]; C=0.863, HLGOF=0.7307 [60-day]; C=0.880, HLGOF=0.4313 [one-year]). Conclusions: Even a moderate level of anemia is independently associated with an increased risk of death during the first year following acute ischemic stroke. Very low or very high Hct is associated with early post-stroke mortality. Further work is required to evaluate whether interventions that treat anemia, its complications and underlying etiologies may also reduce post-stroke mortality.

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Abstract 1911: Recanalization of Proximal Arterial Occlusion in the SENTIS Trial

Stroke ◽

10.1161/str.43.suppl_1.a1911 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

David S Liebeskind ◽

Ashfaq Shuaib ◽

Martin Köhrmann ◽

William P Dillon ◽

Songling Liu ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical History ◽

Controlled Trial ◽

Arterial Occlusion ◽

Stroke Severity ◽

Nihss Score ◽

Logistic Regression Models ◽

Multivariable Logistic Regression

Background: Collateral circulation may enhance recanalization in acute ischemic stroke. Augmentation of collaterals with partial aortic occlusion may promote recanalization and thereby influence outcomes in the SENTIS randomized controlled trial of the NeuroFlo device. We conducted a post hoc analysis of angiography acquired in SENTIS to evaluate potential differences in recanalization rates between NeuroFlo-treated and non-treated arms, accounting for site of arterial occlusion. Methods: Blinded imaging expert review of baseline and 6-hour follow-up angiography (CTA, MRA, or DSA) from the core lab was conducted for evaluation of recanalization. Recanalization was defined as TIMI 2-3 in the arterial segment distal to baseline occlusion. Baseline demographics, stroke presentation characteristics, and medical history variables were analyzed with respect to recanalization in univariate and subsequent multivariable logistic regression models after adjusting by treatment arm. Results: Serial angiography was available in 109/515 SENTIS subjects, including 56 in the treatment arm and 53 in the non-treated arm. Baseline demographics, stroke presentation characteristics, and medical history variables did not differ statistically between arms. Across all sites of arterial occlusion, recanalization occurred in 25.7% of cases, with similar rates between device (25.0%) and medical therapy (26.4%) arms. Age and baseline stroke severity (NIHSS score) were significant predictors of recanalization in univariate analyses. Multivariable logistic regression analyses confirmed that baseline NIHSS score was the sole predictor of recanalization (OR 0.90, p=0.0458) per one unit increase, with decreased recanalization in more severe strokes. Device treatment was not associated with significant increases in recanalization rates (p=NS). Recanalization of terminal internal carotid artery (12.5%), proximal MCA or M1 (17.9%) and M2 (46.7%) occlusions was not different between arms (all p=NS). Recanalization of proximal arterial occlusion in acute ischemic stroke cases enrolled in SENTIS was more frequent in M2 occlusions. Conclusions: More severe strokes at baseline were less likely to recanalize and device therapy did not increase recanalization rates. Treatment with the NeuroFlo device may invoke mechanisms of collateral perfusion distinct from direct arterial recanalization.

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